What Are the Common Problems with Surgery on the Lower Eyelids?

Doctor Answers 9

While lower eyelid surgery is basically very safe, it needs to be performed expertly.

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Lower eyelid cosmetic surgery continues to be the area where surgeons can create significant complications despite performing a standard surgery.  A big reason for this is that for the most part, the paradigm for lower eyelid surgery is fundamentally flawed.  The general plastic surgery literature oversimplifies the anatomic approach to the lower eyelid and the key papers in my opinion incorrectly present the anatomy.  Plastic surgeons continue to use the trancutaneous lower eyelid incision to approach lower eyelid fat.  This is done through a cut just under the lower eyelid lashes and the muscle just under the skin.  According to key papers in the plastic surgery literature, this leads the surgeon into a potential space and the dissection can be done without damaging the   nerves that supply the muscle that supports the lower eyelid.  This description is not actually based on observation but rather just a theory.  Many other papers do not support this description.  This is consistent with clinical experience with many injuries and lower malpositions developing after this type of lower eyelid surgery.  The problem is often compounded because the surgeon attempts to correct an unrecognized motor nerve injury by tightening the lower eyelid (canthoplasty).  This often further compromises the lower eyelid position.  I know because I make a living fixing this type of situation.

The answer is to avoid having a surgery that violated the muscle plane.  It is important to have an explicit conversation with your potential surgeon regarding what approach they are planning.  If they are not prepared to have this detailed a conversation with you about your eyelid surgery, you should consider seeing a different surgeon.

Other complications, sure there are many other potential complications but they are less frequent.  The important thing is to really do your homework and understand what is being proposed to you.  If you can understand the anatomy that I have described you will be ahead of many plastic surgeons offering lower eyelid and transcutaneous mid face surgery out there.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Common and uncommon side effects

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Thank you for your question. Typically, major complications are unusual. Dangerous complications include infection (which in most cases is treated with an antibiotic), continuous bleeding after blepharoplasty, excessive tearing, double vision, or in very rare cases loss of vision. 
Common side effects that you can expect is bruising, swelling, minor pain/discomfort.
Best of luck!

Dhaval M. Patel
double board certified
Plastic surgeon
Hoffman Estates

Lower eyelid malposition

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Lower eyelid malposition is the most common problem seen in lower eyelid surgery. Though there are many other possible, yet less common, complications that can occur from dry eyes and asymmetry to scary things such as vision loss [very rare].

I'm sure that with the help of google you can find enough references to scare you away. If you are serious however, I recommend a consultation with an experience ASOPRS trained oculoplastics surgeon.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Problems after Lower Eyelid Blepharoplasty

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Significant problems after a lower eyelid blepharoplasty are uncommon.  Some of the problems seen after lower eyelid blepharoplasty include: 

Chemosis-fluid collection under the lining of eye.  Generally treated with steroid eye drops. 

Lower lid malposition/scleral show-prevented by avoiding resection of too much skin.

Ectropion-rolling out of the lower lid.  Prevented by avoiding aggressive skin resection and supporting the tendon at the corner of the eye.

Hollow eyes-prevented by avoiding aggressive fat removal.

Dry eyes-prevented by avoiding too much exposure of the globe with excessive skin removal.

Michael Sundine, MD
Orange County Plastic Surgeon

More important than the surgery...is the surgeon

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You phrased the question very well..."problems" rather than "complications." Postoperatively, you can expect some bruising and swelling. At least initially, there may be some ectropion, which is the eyelid is turned down. This almost always resolves if the treatment is performed by a board certified plastic surgeon.

Lower eyelid surgery

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Some of the complications of lower lid surgery include ectropion ( pulling  down of the lower lid), chemosis (swollen conjunctiva) which may lead to persistent swelling and eye irritation, unfavorable scarring, infection, and hematoma or bruising. 

Lower eyelid surgery problems

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The lower eyelids are a very complex area to operate on.  Especially when they become looser with age, they are prone to drift down from surgery causing a rounding out and an increased showing of the white part of the eye.  Even worse, they can pull down enough to be called an ectropion.  Other common problems are cosmetic dissatisfaction as patients frequently expect tighter smoother results than the lower lid will allow for.  Aggressive surgery here can cause disasters.

Lower lid complications

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The most common problems with lower eye lid surgery include : ectropion,lower lid rounding,excessive fat removal,inadequate fat removal,prolonged swelling,bleeding,and scarring. The majority of these compications could be prevented by proper surgical planning and proper surgical technique.

Lower eyelid anti-aging procedure

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Usually, all goes well, and results very beautiful, youthful, and gratifying. Possible problems: asymmetry between right and left sides, dissatisfaction with result, internal scarring with lower eyelid malposition, cysts, chronic or transient discomfort and /or visual difficulties, need for surgical revision, visible scar(s), suface contour irregularity, dry eyes, tearing of eyes, a feeling of irritation of the eyes, inability to completely close the eyes, prolonged swelling, and others.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.